The comparison of the commonly used surrogates for baseline renal function in acute kidney injury diagnosis and staging.

dc.contributor.author

Thongprayoon, Charat

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Cheungpasitporn, Wisit

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Harrison, Andrew M

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Kittanamongkolchai, Wonngarm

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Ungprasert, Patompong

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Srivali, Narat

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Akhoundi, Abbasali

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Kashani, Kianoush B

dc.date.accessioned

2023-10-11T19:48:36Z

dc.date.available

2023-10-11T19:48:36Z

dc.date.issued

2016-01

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2023-10-11T19:48:35Z

dc.description.abstract

Background

Baseline serum creatinine (SCr) level is frequently not measured in clinical practice. The aim of this study was to investigate the effect of various methods of baseline SCr determination measurement on accuracy of acute kidney injury (AKI) diagnosis in critically ill patients.

Methods

This was a retrospective cohort study. All adult intensive care unit (ICU) patients admitted at a tertiary referral hospital from January 1, 2011 through December 31, 2011, with at least one measured SCr value during ICU stay, were included in this study. The baseline SCr was considered either an admission SCr (SCrADM) or an estimated SCr, using MDRD formula, based on an assumed glomerular filtration rate (GFR) of 75 ml/min/1.73 m(2) (SCrGFR-75). Determination of AKI was based on the KDIGO SCr criterion. Propensity score to predict the likelihood of missing SCr was used to generate a simulated cohort of 3566 patients with baseline outpatient SCr, who had similar characteristics with patients whose outpatient SCr was not available.

Results

Of 7772 patients, 3504 (45.1 %) did not have baseline outpatient SCr. Among patients without baseline outpatient SCr, AKI was detected in 571 (16.3 %) using the SCrADM and 997 (28.4 %) using SCrGFR-75 (p < .001). Compared with non-AKI patients, patients who met AKI only by SCrADM, but not SCrGFR-75, were significantly associated with 60-day mortality (OR 2.90; 95 % CI 1.66-4.87), whereas patients who met AKI only by SCrGFR-75, but not SCrADM, had a non-significant increase in 60-day mortality risk (OR 1.33; 95 % CI 0.94-1.88). In a simulated cohort of patients with baseline outpatient SCr, SCrGFR-75 yielded a higher sensitivity (77.2 vs. 50.5 %) and lower specificity (87.8 vs. 94.8 %) for the AKI diagnosis in comparison with SCrADM.

Conclusions

When baseline outpatient SCr was not available, using SCrGFR-75 as surrogate for baseline SCr was found to be more sensitive but less specific for AKI diagnosis compared with using SCrADM. This resulted in higher incidence of AKI with larger likelihood of false-positive cases.
dc.identifier

10.1186/s12882-016-0220-z

dc.identifier.issn

1471-2369

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1471-2369

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https://hdl.handle.net/10161/29264

dc.language

eng

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Springer Science and Business Media LLC

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BMC nephrology

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10.1186/s12882-016-0220-z

dc.subject

Humans

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Creatinine

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Glomerular Filtration Rate

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Ambulatory Care

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Patient Admission

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Severity of Illness Index

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Sensitivity and Specificity

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Retrospective Studies

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Aged

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Aged, 80 and over

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Middle Aged

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Intensive Care Units

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Female

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Male

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Mathematical Concepts

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Propensity Score

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Acute Kidney Injury

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Biomarkers

dc.title

The comparison of the commonly used surrogates for baseline renal function in acute kidney injury diagnosis and staging.

dc.type

Journal article

duke.contributor.orcid

Srivali, Narat|0000-0002-6945-329X

pubs.begin-page

6

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1

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Duke

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School of Medicine

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Clinical Science Departments

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Medicine

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Medicine, Pulmonary, Allergy, and Critical Care Medicine

pubs.publication-status

Published

pubs.volume

17

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